目的 观察急性重症胰腺炎(severe acute pancreatitis,SAP)早期经三腔喂养管给予通腑胰胆汤的治疗效果。方法 随机将急性重症胰腺炎患者分为A组(n=22)、B组(n=21)和C 组(n=21)。在给予重症监护、抗感染、生长抑素抑制胰腺分泌、液体复苏、维持水电解质平衡等常规综合治疗的基础上,A组早期经胃管给予通腑胰胆汤、B组早期经三腔喂养管给予通腑胰胆汤、C组为对照组,经胃管给予乳果糖。分别检测各组患者在相同时间点的APACHEII评分与超敏C反应蛋白水平,观察经不同途径给予中药或乳果糖时患者耐受程度、肠道动力功能恢复时间以及住院时间。结果 A组和B组在入院后第7天APACHEII评分、超敏C反应蛋白水平明显低于C组(5.30±2.15 vs 6.95±2.25, P<0.05; 5.45±1.80 vs 6.95±2.25,P<0.05)。早期经三腔喂养管给予通腑胰胆汤治疗组,患者出现恶心、呕吐、腹痛加重的胃肠道症状发生率明显低于经胃管途径给药组(14.3% vs 45.5%,P<0.05),且该组患者的肠道功能恢复时间明显短于经胃管给药组[(6.67±1.49)d vs (8.36±2.54)d, P<0.05]。两种途径给予通腑胰胆汤治疗组患者的住院时间显著短于乳果糖治疗组[(15.73±2.68)d vs (19.24±6.42)d, P<0.05;(14.86±2.86)d vs (19.24±6.42)d, P<0.05]。结论 早期经三腔喂养管给予此中药能明显提高给药依从性,减少恶心、呕吐发生,缩短肠道功能恢复时间,缩短住院时间,使预后得到明显改善。

Objective To observe the efficacy of early feeding Tongfuyidan decoction in the treatment of SAP by three-lumen gastrojejunal tube. Methods Patients with severe acute pancreatitis were randomly divided into group A (n=22), group B (n=21) and group C (n=21).Based on routine comprehensive treatment, such as intensive care , anti-infection, somatostatin inhibition of pancreatic secretion, fluid resuscitation, maintenance of water and electrolyte balance .group A was given Tongfuyidan decoction by nasogastric feeding, while group B was given Tongfuyidan decoction by three-lumen gastrojejunal tube feeding, and patients in control group were given lactulose by nasogastric feeding. Patients in each group received measurments at the same point in time of APACHE Ⅱ score, serum amylase, high-sensitivity C-reactive protein , and the tolerance, the recovery time of intestinal function and hospital stay of patiens feeded by medicine or lactulose through different routes. Results On day 7 after admission, both the APACHE Ⅱ score and high-sensitivity C-reactive protein in group A and group B were significantly lower than those in group C(5.30±2.15 vs 6.95±2.25, P<0.05; 5.45±1.80 vs 6.95±2.25, P<0.05). The incidence rate of nausea, vomiting, aggravated abdominal pain in group B was dramatically lower than in group A(14.3% vs 45.5%,P<0.05). Similarly, the recovery time of intestinal function in group B was also notably shorter than in group A(6.67±1.49 vs 8.36±2.54, P<0.05). The hospital stay in two groups given Tongfuyidan decoction were significant shorter than in lactulose treatment group[(15.73±2.68)d vs (19.24±6.42)d, P<0.05;(14.86±2.86)d vs (19.24±6.42)d, P<0.05]. Conclusions Early feeding through three-lumen gastrojejunal tube can significantly improve dosing compliance, reduce incidence of nausea and vomiting, shorten recovery time of intestinal function , shorten hospital stay, so improved the prognosis significantly.